Abstract
Background
The Uniform Law Commission paused work of the Drafting Committee to Revise the Uniform Determination of Death Act (UDDA) in September 2023.
Methods
Thematic review was performed of comments submitted to the Uniform Law Commission by medical organizations (MO), organ procurement organizations (OPO), and advocacy organizations (AO) from 1/1/2023 to 7/31/2023.
Results
Of comments from 41 organizations (22 AO, 15 MO, 4 OPO), 34 (83%) supported UDDA revision (50% OPO, 33% MO recommended against revision). The most comments addressed modifications to “all functions of the entire brain, including the brainstem” (31; 95% AO, 75% OPO, 47% MO), followed by irreversible versus permanent (25; 77% AO, 50% OPO, 40% MO), accommodation of brain death/death by neurologic criteria (BD/DNC) objections (23; 100% OPO, 80% MO, 32% AO), consent for BD/DNC evaluation (18; 75% OPO, 47% MO, 36% AO), “accepted medical standards” (13; 36% AO, 33% MO, 0% OPO), notification before BD/DNC evaluation (14; 100% OPO, 53% MO, 9% AO), time to gather before discontinuation of organ support after BD/DNC determination (12; 60% MO, 25% OPO, 9% AO), and BD/DNC examiner credential requirements (2; 13% MO, 0% AO, 0% OPO). The predominant themes were that the revised UDDA should include the term “irreversible” and shouldn’t (1) stipulate specific medical guidelines, (2) require notification before BD/DNC evaluation, or (3) require time to gather before discontinuation of organ support after BD/DNC determination. Views on other topics were mixed, but MO and OPO generally advocated for the revised UDDA to take a functional approach to BD/DNC, not require consent for BD/DNC evaluation, and not require opt-out accommodation of BD/DNC objections. Contrastingly, many AO and some MO with religious affiliations or a focus on advocacy favored the revised UDDA take an anatomic approach to BD/DNC or eliminate BD/DNC altogether, require consent for BD/DNC evaluation, and require opt-out accommodation of BD/DNC objections.
Conclusions
Most commenting organizations support UDDA revision, but perspectives on the approach vary, so the Drafting Committee could not formulate revisions that would be agreeable to all stakeholders.
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References
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: medical, legal and ethical issues in the determination of death. Washington D.C.; 1981.
Lewis A, Cahn-Fuller K, Caplan A. Shouldn’t dead be dead?: the search for a uniform definition of death. J Law Med Ethics. 2017;45:112–28.
Lewis A, Bonnie RJ, Pope T. It’s time to revise the uniform determination of death act. Ann Intern Med. 2020;172:143–4.
Shewmon DA. Statement in support of revising the uniform determination of death act and in opposition to a proposed revision. J Med Philos. 2021;Epub ahead of print.
Nguyen D. Does the uniform determination of death act need to be revised? Linacre Q. 2020;87:317–33.
Dalle Ave AL, Bernat JL. Inconsistencies between the criterion and tests for brain death. J Intensive Care Med. 2020;35:772–80.
Robbins N, Bernat J. What should we do about the mismatch between legal criteria for death and how brain death is diagnosed? AMA J Ethics. 2020;22:e1038–46.
Lewis A. Contentious ethical and legal aspects of determination of brain death. Semin Neurol. 2018;38:576–82.
Lewis A, Pope TM. Physician power to declare death by neurologic criteria threatened. Neurocrit Care. 2017;26:446–9.
Lewis A, Bonnie RJ, Pope T, Epstein LG, Greer DM, Kirschen MP, et al. Determination of death by neurologic criteria in the United States: the case for revising the Uniform Determination of Death Act. J Law, Med Ethics. 2019;47:9–24.
Jahi McMath and Nailah Winkfield vs. State of California, County of Alameda, Alameda County Department of Public Health, Muntu Davis, MD, MPH, Alameda County Coroner and Medical Examiner, Alameda County Counsel, David Nefouse, Scott Dickey, Alameda County. 2015. p. 3:15-CV–06042.
Re: Guardianship of Hailu. 2015. p. 361 P.3d 5.
Re: Allen Callaway. 2016. p. DG-16–08.
Re: Mirranda Grace Lawson. 2016. p. CL16–2358, City of Richmond Circuit Court.
Alex Pierce v. Loma Linda University Medical Center. 2016.
Israel Stinson v. UC Davis Children’s Hospital. 2016. p. S-CV-0037673.
Uniform Law Commission [Internet]. [cited 2023 Sep 12]. Available from: https://www.uniformlaws.org/aboutulc/overview
Lewis A. The Uniform Determination of Death Act is being revised. Neurocrit Care. 2022;36:335–8.
Truog RD. The uncertain future of the determination of brain death. JAMA. 2023;329:971–2.
Buscher S. The Uniform Determination of Death Act (UDDA) [Internet]. Am Life Leag. 2023 [cited 2023 Sep 14]. Available from: https://www.all.org/guest-commentary/the-uniform-determination-of-death-act-udda
Marcus A. Doctors and lawyers debate meaning of death as families challenge practices. Wall Str J. 2022.
Mantle L. Not everyone agrees on what determines death. A committee is reviewing whether the definition needs an update. Airtalk with Larry Mantle. 2022.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
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Ariane Lewis has no financial conflicts of interest. Ariane Lewis represents the American Academy of Neurology as an observer on the UDDA Drafting Committee.
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Lewis, A. Perspectives of Medical Organizations, Organ Procurement Organizations, and Advocacy Organizations About Revising the Uniform Determination of Death Act (UDDA). Neurocrit Care (2023). https://doi.org/10.1007/s12028-023-01872-5
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DOI: https://doi.org/10.1007/s12028-023-01872-5